Long Before the Crisis

September 2026 | National Suicide Prevention Awareness Month | Robyn Hussa Farrell

Public health people love to tell the story of a person standing beside a river and notice that someone is drowning. They jump in and pull them out. Then another. And another. Eventually somebody has to walk upstream and find out why so many people are falling in.

The 2024 National Strategy for Suicide Prevention makes that walk a goal of its own.

It calls for upstream, community-based prevention, and it highlights the urgent need within youth populations (U.S. Department of Health and Human Services, 2024). The research shows us that risk and protective factors overlap and that connectedness and coping protect a young person (Neumark-Sztainer et al., 2007).

I didn't start upstream. I started in the river.

From 2006 to 2012, I taught yoga and mindfulness-based stress reduction inside eating disorder and substance use treatment centers. I was also quietly considering a clinical degree.

I remember how young so many of the patients were. I remember how many were in acute distress... and how many were actively suicidal. I remember wondering what might have happened if someone had reached them years earlier.

So I chose primary prevention instead. Upstream.

In 2007, there were very few engaging, evidence-based models for helping young people build resilience. So I started building them, with epidemiologists, with educators, with parents and with varying ages of youth.

Our first school program was a musical.

I was a theatre person long before I was a prevention person. NORMAL the Musical toured schools with clinicians leading the conversation after the curtain came down. More than 50,000 audience members saw it, including during a four-performance run at the Edinburgh Fringe. What those audiences asked us, in more than 10,000 surveys, became the foundation of the documentary film library we still build on today.

The walk upstream.

From 2006 to 2019, we served 87,792 people across 714 documented trainings. They took place in schools, universities, hospitals, treatment centers, faith communities and community organizations. Our eating disorder and serious mental illness programs expanded to 14 states.

Through 2017, we documented 3,513 times that a participant came forward to talk with a clinician, or entered treatment, after one of those programs.

In upstate South Carolina, the United Way of the Piedmont Behavioral Health Task Force and Suicide Prevention Task Force grew from five members to more than 90. The South Carolina Office of Suicide Prevention, then led by Dr. Alex Karydi, invited me to certify as a CONNECT postvention trainer. Our coalition brought the field's gold-standard models to communities, first regionally and then statewide: Mental Health First Aid, QPR, LivingWorks safeTALK, ASIST, and CONNECT. More than 5,000 South Carolina educators learned the "5 Minute Mindfulness™" program through Resilient Schools and Compassionate Schools initiatives. In Spartanburg District 7 alone, 700 educators trained with us, and 92% said they felt more confident managing serious mental illness in their schools (Anderson et al., 2017).

Clinicians and researchers built every one of those models. Every one of them taught me something that ended up in Sharpen®.

Where Sharpen® is today.

Our four-hour Sharpen® Suicide Prevention and Postvention course covers screening, digital safety planning, prevention best practices, and supporting a community after a loss. Here is some of what youth-serving organizations are doing with it, and with the platform behind it.

• In New York City, the course is the professional training component of VNS Health Safe Pathways. This five-year initiative is funded by the New York State Office of Mental Health and serves LGBTQI+ and BIPOC youth and families. It has issued more than 200 certifications (New York State Office of Mental Health, 2025). Across 23 cohorts, participants have reported growing confidence in helping someone who is suicidal. The largest gains came in knowing the resources and connecting a person to them. A formal evaluation is underway.

• In Division I athletics, 1,275 student athletes completed adaptive screening with CAT-MH®, including the CAT-SS suicide scale, through Sharpen® DTX over three years. Of those athletes, 126 were flagged for elevated suicide risk. Every one of them received clinical triage, safety planning and crisis intervention on the same day (Davis et al., 2026).

Every one. Same day.

• At the Edward Via College of Osteopathic Medicine, a SAMHSA Garrett Lee Smith grant funded Mindful MEDS, a suicide prevention program for medical students built on Sharpen®. Every participating student reported greater awareness of suicide prevention strategies.

• In a college mental health literacy course, undergraduates named suicide prevention as the most important topic they learned (Levy et al., 2026).

• In South Carolina, foster parents completing our certified parent education program showed significant gains in resilience and self-compassion over three years (Biber et al., 2026). Both are established protective factors.

• The University of Washington SMART Center curated Sharpen® Mental Health Literacy into its independently reviewed library of high school mental health curricula.

• We are the suicide prevention, resiliency and mental health literacy platform for youth serving organizations in NY, GA, SC, and TX. And 98% of kids recommend our product to their friends.

Every Sharpen® toolkit, clinical or not, carries crisis support resources, 988 routing and locally vetted treatment providers.

Our clinical deployments add screening, real-time triage and a digital safety plan (Stanley & Brown, 2012). Since August 2019, 64,156 people have used the platform. Among users who took a help-seeking step, 84.8% had engaged with our content first.

On one university campus, across three years of analytics, the single most-viewed module in our entire library was "Know the warning signs for suicide."

Young people are not avoiding this conversation. They are looking for it.

Twenty years in, I am still listening, learning and truly humbled by the journey. We walk upstream alongside the schools, universities, coaches, foster families and community organizations who trust us to walk with them. To every one of them, thank you. This month, and every month.

If you or someone you love is struggling, call or text 988, or chat at 988lifeline.org. Help is available, and you don't have to wait for a crisis to reach out.

References

Anderson, C. N., Holody, K. J., Flynn, M. A., & Hussa-Farrell, R. (2017). An exploratory evaluation of the feasibility, acceptability, and efficacy of the mental fitness disordered eating program in schools. Eating disorders, 25(3), 230–245. https://doi.org/10.1080/10640266.2017.1289793

Biber, D. D., Hussa Farrell, R., & Farrell, T. (2026). Mental health literacy training for foster parents: A three-year implementation and analysis [Preprint]. SSRN. https://doi.org/10.2139/ssrn.6624959

Davis, A., Biber, D., Stewart, B., Cosgrove, V., Minkel, J., Wulczyn, H., Farrell, T., & Hussa Farrell, R. (2026). Integrated clinical triage platform for athlete mental health and suicide prevention: Real-time decision support enabling 100% same-day intervention across 1,275 student-athletes [White paper]. Resiliency Technologies, Inc.

Levy, J., Hussa Farrell, R., Farrell, T., Pish, M., Fassas, J., Reed, E., Hinshaw, S., & Biber, D. (2026). A program evaluation of the Sharpen® Mental Health Literacy college course at a southeastern university in the United States [Manuscript submitted for publication].

Neumark-Sztainer, D. R., Wall, M. M., Haines, J. I., Story, M. T., Sherwood, N. E., & van den Berg, P. A. (2007). Shared risk and protective factors for overweight and disordered eating in adolescents. American Journal of Preventive Medicine, 33(5), 359-369. https://doi.org/10.1016/j.amepre.2007.07.031

New York State Office of Mental Health. (2025). VNS Health Safe Pathways program: Year 3 evaluation findings [Internal evaluation report].

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

U.S. Department of Health and Human Services. (2024). 2024 national strategy for suicide prevention. https://www.hhs.gov/sites/default/files/national-strategy-suicide-prevention.pdf

"Young people are not avoiding this conversation. They are looking for it."